At The Helm: United States Foreign Policy and Reproductive Rights

In January 1973, the United States Supreme Court passed Roe v. Wade. That case, a watershed decision, acknowledged a constitutional right to abortions and rejected a theory of personhood based on religious convictions, creating a more secular national policy.1Roe v. Wade shifted the national understanding of abortion from a largely criminal enterprise to an accessible medical procedure. Rather than a moral issue, the court case reframed the right to abortion in terms of privacy, individuality, and control. The decision not to have a child became an issue of agency and autonomy, not life or death. The question of regulation depended on the point at which a pregnancy entered the public domain; when the government could begin to exercise its claimed interest in a woman’s body (specifically, in her womb).

Icon representing women’s health. Source: Kaldari, Wikimedia Commons.

A flood of legislation assailed this decision, carefully excising abortion from US policy and programs.3 The Helms Amendment, one of the first laws passed in reaction to Roe, states, “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”2 The amendment shifted the US government away from a pro-choice stance, by refusing to monetarily endorse abortion. The United States enacted this law in spite of the fact that abortion had just been recognized as a right for women within its boundaries, and the inequitable, hypocritical moral imperialism of this double standard still haunts US foreign policy today.

The United States Agency for International Development (USAID) openly pointed out this contradiction when first confronted by the legislation. USAID wrote that, while the Foreign Assistance Act “explicitly acknowledges that every nation is and should be free to determine its own policies and procedures with respect to population growth and family planning,” the Helms Amendment worked against these principles, placing “US restrictions on both developing country governments and individuals in the matter of free choice among the means of fertility control…that are legal in the US”2 Even interpreted in its most generous iteration, the Helms Amendment restricts women’s reproductive rights and erodes the internal sovereignty of the 140 nations to which the US provides aid.

After Roe v. Wade, the judiciary branch of the United States government set to work corroding the reproductive rights of women within its borders, case by case. In 1992, the Supreme Court upheld a Pennsylvania law that required a 24-hour waiting period between a doctor’s visit and the abortion procedure, excising only the clause that required wives to acquire written permission from their husbands before receiving an abortion. In 2006, the court also sustained the Partial-Birth Abortion Ban Act despite noted factual inaccuracies in the Act, including scientific findings that directly contradicted those of the American College of Obstetrics and Gynecology.5

Pro-life states continue to restrict access to abortion, and have begun to directly attack abortion clinics. Ten states currently mandate that women receive an ultrasound before an abortion, and that doctors offer the woman a chance to see the images.3 In some ways, Donald Trump’s recent comment that women who have abortions “must be punished in some way” reflects what pro-life activists have carefully avoided saying for a long time: that women who have abortions are degenerate, amoral, and have gone astray. These women must be lead back to the fold, but not too gently. They must be forgiven, but not all too quickly.

A pro-choice protest. Source: Madmanmikey, Flickr.

The legal structure enacted in Roe v. Wade has been slowly eroded since its passage, but the legal apparatus replacing the right to abortion has existed in US foreign policy since 1973. The Helms Amendment and its satellite amendments reveal a legal structure that seeks to remove abortion from the national consciousness and dialogue. The Siljander Amendment bans the use of US foreign aid to lobby for or against abortion, the Biden Amendment bans the use of US foreign aid to fund biomedical research related to abortion, and the newly-repealed Mexico City Amendment required non-governmental organizations (NGOs) to certify that they will not use US foreign funds to perform abortions.2 Each of these amendments institutionalizes governmental disapproval and disavowal of abortions, not only as a medical procedure, but also as a moral choice. The careful, detailed purge of US support ensures that abortion remains a charged procedure, enacted against the wishes of the US government. Helms and its accessories, even if watered down to their gentlest forms, export a severely attenuated version of reproductive rights, a version in which abortion is neither allowed nor discussed.

Furthermore, these amendments are not instituted in their gentlest possible forms. For instance, USAID has adopted a policy that bans the purchase of manual vacuum aspiration kits and misoprostol, a drug useful not only for abortions, but also for the treatment of incomplete abortions and postpartum hemorrhage.10 Furthermore, NGOs, fearful of being defunded, often hesitate to provide abortion counseling to women who have been victims of sexual violence.1 Although the language of the legislation implies certain exceptions, banning abortion “as a method of family planning,” but not in cases of rape or incest have not been carried out in real-world implementations of the Helms Amendment. The amendment also restricts care available to women emerging from war zones and, in doing so, denies these women both agency and autonomy.

Of the approximately 44 million abortions that take place annually, half occur under unsafe conditions, undertaken by women desperate enough to seek untrained practitioners and procedures that “do not conform to minimal medical standards.”12,13 Each year, 47,000 women die of botched abortions, and many more are injured.14 The bulk of these deaths occur in developing nations. The history of abortion in the US, pre-Roe v. Wade—think gory images of coat hanger abortions and unanesthetized women bleeding out on the table—that we hear from pro-choice activists is still a reality for much of the developing world. By denying access to safe abortions to women abroad, US foreign policy codifies unequal abortion access, access which is already too limited within our borders.

South African actress Andrea Dondolo on Table Mountain in Cape Town, as part of One Billion Rising, to call for an end to violence against women and girls. Source: Lindsay Mgbor/DFID.

The Helms Amendment is not simply a question of choice, but of fundamental rights. The World Health Organization (WHO) defines access to safe abortions as a human right.15 Moreover, a recent WHO report on the prevalence of violence against women highlighted the need for a more effective, holistic response to sexual assault from the healthcare sector.16 The WHO called for comprehensive treatment for victims of sexual violence, including abortion (in nations where abortion is legal).17 US foreign policy fails to live up to international standards of care for women. This failure is particularly egregious considering the long history of rape as a tool of war. Women who escape from regions of conflict and violence often find themselves with unwanted pregnancies as a result of rape, because US foreign policy refuses to provide access to safe abortions, thus stripping these women of a sense of control over their own bodies and lives.

For women who escape from terror groups like Boko Haram, which use sexual violence as means of control or reproduction, loss of bodily autonomy is a daily hazard. Boko Haram arrived on the public radar for many when, two years ago, they kidnapped almost 300 Nigerian schoolgirls. The girls are still missing and Boko Haram continues to ravage cities in Nigeria with suicide bombings and kidnappings.18 Women are taken from their homes and repeatedly raped, as militants in Boko Haram have been said to “pray before mating, offering supplications for God to make the products of what they are doing become children that will inherit their ideology.”19 When women escape to camps for displaced persons, they are often met with policies that refuse to acknowledge the depth of the violation they have experienced, as well as policies that ignore the issue of unwanted pregnancies and their implications for women’s mental and physical health.

Pressure from NGOs like Ipas, which provides safe, respectful, and comprehensive abortion care, and PAI, which advocates for global reproductive rights, have resulted in promises from Democratic presidential nominees to change the interpretation of the Helms Amendment, or even to overrule it. These promises represent a passable start, but a more thorough overhaul of this country’s dedication to reproductive rights as a whole is in order. Abortion legislation cannot represent a way to control and regulate female bodies. The Helms amendment does not show the failure of US foreign policy alone, but reveals a far more insidious and threatening truth about the government’s commitment to women, both within its borders and beyond.

The Helms Amendment sets up a contract for aid where the onus is placed on the individual female body. In doing so, this law perpetuates a moral imperialism where women are stripped of the ability to choose, despite the alleged right to do so. The government commits this damage in the name of women’s health. But a policy that restricts abortion is not a policy “for women’s health,” when tens of thousands of women die of unsafe abortions every year, and hundreds die of complications from childbirth every day. The Helms Amendment, and the domestic policies that seek to reproduce its limitations within US borders, commits an act of violence. The role of the US government is not to regulate bodies from afar, nor to implement inequality between women of developing and developed nations. And the role of USAID is certainly not to participate in the erosion of women’s autonomy and control over their bodies. Aid may be conditional, coercive, and self-serving, but it should never enforce societal norms that harm women and turn wombs into obligations. The Helms Amendment violates the very women that it allegedly tries to help, and, as a result, cannot be called aid at all.

Aviva Rabin-Court is a sophomore in Saybrook College majoring in Molecular, Cellular & Developmental Biology. She can be contacted at aviva.rabin-court@yale.edu.